Differences in sepsis from skin and soft tissue infections among patients with vs. without mental health disorders

Introduction Sepsis is a severe health condition that requires rapid and attentive treatment. The rise in sepsis cases reveals a lack of immediate supportive care in the healthcare system. This lapse may be attributed to a delay in sepsis recognition, patient incompatibility with care plan, and conditions that make treatment more difficult. Building on previous research, this paper seeks to explore the correlation between patients with mental health conditions and sepsis development. State how we define quality of sepsis care. Method Data from 2018-2019 from our ED sepsis quality database was analyzed using T-tests, comparing the characteristics, conditions, and quality of sepsis care of dermatologically-septic patients with and without mental health conditions. Results Between January 1, 2018 and December 31, 2019, 584 LIJ ED patients had sepsis that met inclusion criteria for quality review. Of these, 57 (9.8%) had sepsis of dermatologic origin, of which 30 (52.6%) were female (p = 0.4318). The source of sepsis was the lower extremity in 36.8% of mental health patients vs. 68.4% of non-mental health patients (p = 0.045) and sacral decubitus ulcer in 36.8% of mental health patients vs. 5.3% of non-mental health patients (p = 0.004). In neither univariate nor multivariate analysis were there statistically-significant differences in outcomes in patients with vs. without a mental health issue. However, the need for mechanical ventilation trended lower among patients with mental health disorder (p = 0.141) while the outcome of 3-hour bundle met trended higher among that same group (p = 0.11). Discussion Compared to patients with mental health issues, those without mental health issues had higher rates of sepsis due to lower extremity infections and sacral decubitus ulcer infections. None of the outcome variables met statistical significance. However, dermatologic sepsis patients without mental health issues tended to be more sick than those with mental health issues, as gauged by rates of septic shock and ICU admission (both trending toward statistical significance). They also trended toward receiving lower quality care, as measured by adherence with the 3-hour sepsis bundle. Failure to achieve statistical significance might be due to the small sample size. This is likely the case, as, for example, there was a substantial difference in the percent of multi-racial patients between those with (5.3%) vs. without (28.9%) mental health illness, yet even this large difference did not meet statistical significance (p = 0.104).